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PRIMARY BONE TUMORSDR.MUNENEThe generally areSolitaryLocalisedSlow growingEnlarges by pressure and expansionDo not metastasize (though benign tumours like GCT and chondroblastoma have been known to metastasize)2BENIGN BONE TUMOURS2GENERAL CHARACTERISTICS OF BONE TUMOURS

Age at presentationPeak incidenceRange of common incidence

1 malignant tumoursCharacterized by ability to spread to other regions not in continuitySpread usually via bloodstreamAlso by lymph/ CSF/ serous cavities/ bone marrow spacesUnremitting growth periodic variation

Pain

Swelling and tenderness near the affected area

Pathological #

Constitutional S/S Fatigue ,Unintended weight loss, Night Sweatss/sDetectionDiagnosisStaging- prebiopsy- presurgery

Follow-up - mets- recurrence- complications of treatment5ROLE OF IMAGING5PLAIN X-RAYCT SCANRNIMRI6RADIOLOGICAL ASSESSMENT6Medical : Biphosphonates

Surgical : Limb Salvage Surgery : Amputation

Neo- Adjuvanct Therapy : Chemo/Radiotherapy chondrosarcoma-less sensitive ewings sarcoma-very sensitive

mgtLOCATIONRATE OF GROWTHREGULARITY OF THE MARGINPERIOSTEAL REACTIONMATRIX MINERALIZATION8RADIOLOGICAL ASSESSMENT8RADIOLOGICAL ASSESSMENTLOCATIONWithin the skeletonWithin individual bone

RATE OF GROWTHThe radiologist fairs better than the histopathologistAdvancing margin of the lesion: in an actively growing tumour there is little peripheral screlosis. Conversly, least aggressive lesions may be surrounded by a rim of sclerosis

99REGULARITY OF THE MARGINRegular margin and endosteal destruction of the cortex signifies slow growth

PERIOSTEAL REACTIONThere are various types, none being pathognomonic of any particular tumourIt helps to indicate aggressiveness of the tumour10RADIOLOGICAL ASSESSMENT10MATRIX MINERALIZATIONThis depends on extracellular material produced by the tumour:Chondral Ca+ are typically linear, curvilinear, ring-like, punctate or nodularOsseous mineralization is clowd-like & poorly definedFibrous tumours produce the characteristic ground-glass appearance11RADIOLOGICAL ASSESSMENT11

12PERIOSTEAL REACTION12PERIOSTEAL REACTIONThe periosteum is a membrane several cell layers thick that covers almost all of every boneThe only parts not covered by this membrane are covered by cartilageBesides covering the bone and sharing some of its blood supply with the bone, it also produces bone when it is stimulated appropriately

1313PERIOSTEAL REACTIONWith slow-growing lesions, the periosteum has time to produce new boneWith rapidly growing lesions, the periosteum cannot produce new bone as fast. An interrupted pattern results, which may be:a thin shell of calcified new boneone or more concentric shells of new bone over the lesion, sometimes called lamellated or "onion-skin" periosteal reaction.

1414PERIOSTEAL REACTIONIf the lesion grows rapidly but steadily, the periosteum will not have enough time to lay down even a thin shell of boneIn such cases, the tiny fibers that connect the periosteum to the bone (Sharpey's fibers) become stretched out perpendicular to the bone. When these fibers ossify, they produce a pattern sometimes called "sunburst" or "hair-on-end" periosteal reaction, depending of how much of the bone is involved by the process.

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15CHONDROID ORIGINOSTEOID ORIGINCYSTSFIBROUS ORIGIN

16BENIGN BONE TUMOURS16

1717ChondromaOsteochondromaChondroblastomaChondromyxoid fibroma18CHONDROID ORIGIN18CHONDROMA

Commonly central in situation, whence it is referred to as enchondroma, but may be eccentric e.g subperiosteal location periosteal chondromaMultiple enchondromas are found Olliers dse & Maffuccis syndromeAffect tubular bones of the hands & feet in >50%.If it becomes painful in absence of fracture, it should be biopsied.1919CHONDROMA

20Age range of 10-80 yrs, most being in 2nd to 4th decades40% occur in the hands, being x5 more common here than in the feetAre extremely rare in the spine and almost unknown in the skull

20CHONDROMA, radiology

Most arise in the medulla of the phalangesOften eccentric and 75% are solitaryWell circumscribed, round lytic lesions which expand the cortexFlecks of Ca+ may be seen within2121CHONDROMA, radiology

Features of benignity include: